SummaryFollowing two deaths from respiratory failure secondary to opioid toxicity in patients admitted for surgical repair of fractured neck of femur, we retrospectively studied the serum urea and electrolyte concentrations of 1511 consecutive patients requiring surgery for proximal femoral fracture, and calculated their glomerular filtration rate. Five hundred and forty-five (36.1%) patients had renal dysfunction on admission (glomerular filtration rate < 60 ml.

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SummaryIt remains uncertain whether spinal anaesthesia is preferable to general anaesthesia for surgical repair of hip fracture, but one determining factor is the comparative cost. A detailed cost analysis relating to 20 consultants' intended anaesthetic practice (which provided information of consumables used) and data from the Brighton Hip Fracture Database was performed to quantify any difference in the costs of administering spinal versus general anaesthesia for patients with hip fracture. Although spinal anaesthesia took significantly longer to administer (mean (SD) time 31 (15) min vs 27 (16) min; p < 0.0001), the mean (SD) cost of spinal anaesthesia (£193.81 (37.49)) was significantly less than the cost of general anaesthesia (£270.58 (44.68); p < 0.0001). The mean percentage cost of anaesthesia was 3.8% of hospital income per hip fracture, and personnel contributed approximately 46% of this cost. While such considerations indicate that spinal anaesthesia is financially preferable, it is unknown whether differential clinical outcomes between regional and general anaesthesia may offset this apparent monetary advantage.

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